Voices: Should planners recommend genetic testing to clients (or do it themselves)?
Whether we like it or not, part of our job as financial planners is to try to predict the future. One particularly squishy number is accurate life expectancy. Most advisors use averages, but no one is average. There are services that help calculate life expectancy through questionnaires and genetic testing — but should advisors really recommend genetic testing to their clients, or even look into it for themselves?
It’s a question that is gaining in urgency. With the sequencing of the human genome, the number of available tests has burgeoned significantly and some are now commercially available to the public. Financial advisors need to become familiar with two types of genetic testing — polygenic disease and telomere length.
Genetic testing for polygenic disease
Most diseases are polygenic. Diabetes, cancer, and heart disease fit handily in this category. Anywhere from a few to hundreds of gene influence the risk of developing one of these diseases, making their specific cause hard to pin down. For example, we know diabetes runs in many families, but is it due to genes or to the family’s sweet tooth?
Genome-testing company 23andMe previously shared the risk of polygenic diseases with customers who took its tests, but in 2013, the FDA forced the company to quit giving these results. Why? The results were not analytically or clinically validated. As a CFP who’s also a medical doctor, these unproven tests were useful only for scaring people at higher risk for disease or giving them a false sense of comfort if the tests showed their risks for disease is low.
If a client tests positive for a gene that may increase the risk of getting a disease, especially if it is a non-modifiable condition, what are they going to do about it? I joke that we only get so many “worry minutes” and then we die. Do we waste worrying about something that may not happen, especially when the proverbial bus can run us over at any time? As someone who has had a couple of close personal calls with death, I can vouch that we need to focus more on living in the present so we have no regrets at the end. We should encourage our clients to do the same.
If a client has a boring genome (like most people do) and tests negative for any disease risk, are they going to live a healthy lifestyle or will they quit worrying about bad habits and start partying down? An article in the Journal of Immunity and Aging shared various studies of long-lived subjects and studies of twins and it is estimated that 25% of the variation in human longevity can be due to genetic factors. This means the other 75% is due to something else, most likely environment and lifestyle.
What will life, disability, and long-term care insurers do with this information? State laws vary on insurance company access to results although currently insurance companies are not requesting this information. What happens in the future remains to be seen. Either way, if your client shares test results with their doctor, that information will be in the medical record and easy for the insurance company to obtain. Before your client undergoes testing, make sure they are fully insured on all fronts.
23andMe now has clinically validated testing for a few illnesses, including late onset Alzheimer’s disease, so these are now FDA approved. Should we get excited? No. The testing for Alzheimer’s has low predictive value, which means just because a person tests positive for the gene variant doesn’t mean they will get Alzheimer’s and likewise, just because they test negative doesn’t mean they won’t get Alzheimer’s. This test will either make them worry unnecessarily or provide a false sense of security. The low predictive value is one reason the Alzheimer’s Association doesn’t recommend this type of testing.
My conclusion for now? Genetic testing for disease that may have a partial genetic component is in its infancy and shouldn’t be recommended by advisors.
Telomere testing for longevity
Telomere length is another proxy for longevity, and tests are now available to consumers. A telomere is a protective cap of DNA at the end of our chromosomes. Each time our cells divide, our telomeres shorten. Telomeres that are too short no longer protect the cell and the cell dies. Unhealthy habits take a bite out of our telomere length and increase our risk of developing chronic diseases.
There are rare diseases caused by telomere shortening and specific clinical tests are used for these cases. The publicly available telomere testing estimates biological age — for example, if a person is a chronological 32 years old but parties hard, their biological age may be 44 years old. When weighed with other factors such as lifestyle habits and family history, telomere testing may provide the extra wake-up call they need to stop their partying ways if they want to increase their chance of living a long life.
What is the problem with the telomere testing approach? Telomere length varies between individuals, so the definition of normal is very broad. Telomere testing compares a person’s telomere length with the median of the rest of the population. What if someone has genetically short or long telomeres?
To me, these unproven tests were useful only for scaring people at higher risk for disease or giving them a false sense of comfort if the tests showed their risks for disease is low.
Telomere scientists think the most useful way to use telomere testing is to measure telomere length over many years. This way it can be determined if that meditation practice and increased kale intake is doing the job of protecting telomeres. But bad news: Telomere testing can vary as much as 20% lab to lab, so who knows whether the same laboratory that measured a person’s telomere today will be around tomorrow?
My conclusion on telomere testing? It is a waste of money.
What is the benefit of genetic testing?
One argument for testing is it will spur people to make healthy lifestyle changes. We should all strive for a healthy lifestyle since that is the stronger determinant of health. If we wait until something bad happens, or for a test to reveal a problem, it may be too late.
Instead of trying to more accurately pinpoint life expectancy, a better approach is to help clients build resiliency for whatever the world delivers. Have your client save for the day they can no longer work, encourage healthy lifestyle habits and help them complete their bucket list long before they have any hint of their bucket being kicked. Encouraging clients to live fully without regret and to financially prepare for the unknowns provides much greater value than any soothsayer or genetic test could ever match.
Even given the chance testing may spur lifestyle change, for the general population without risk factors for diseases for which specific genetic testing is available, I do not recommend genetic testing.